Fibromyalgia syndrome is a common yet mysterious condition with symptoms of widespread pain and fatigue. The syndrome afflicts five to ten million Americans, women 20 times more often than men. It occurs worldwide with no particular ethnic correlation. It has been proposed by various researchers that the syndrome is caused by such diverse causes as: growth hormone deficiency, relaxin hormone deficiency, autoimmune (rheumatoid) disorder, spinal cord compression, viral infection (heptatisC virus), injection with rubella vaccine, idiopathic nociceptive dysfunction, silicone implants, and other causes. It has even been suggested that fibromyalgia is a psychosomatic symptom of depression.
Nonetheless, the specificity of symptoms indicates a true syndrome, although primary cause versus side-effects remains unknown. In 1994, it became officially recognized as a diagnosis by the Copenhagen Declaration. The two criteria for the diagnosis of fibromyalgia as defined by the American College of Rheumatology (ACR) are: 1) diffuse widespread pain, and 2) the presence of multiple tender points. The latter comprise 18 points that are extremely painful on palpation. These specific sites are at the base of the occiput, the cervical anterior, the trapezius, the supraspinatus, the second rib, the epicondyle on the elbow region, the greater trochanter, the gluteus, and the fat pad on the knee. It should be noted that many of these tender points are not muscle tissue. In fact, some researchers believe that skin, tendons or the subcutaneous fascia are the primary nociceptive dysfunctional tissues. Accordingly, the syndrome is sometimes referred to as Myofascial Pain Syndrome. Although many patients report joint pain, unless those patients also have. rheumatoid or osteo-arthritis, the pain in the joints is referred pain from nearby skin, tendons or muscles. Typically, joints are not swollen as in arthritis.
In addition to pain and tender points, patients may experience a disturbed sleep cycle, tension headaches, irritable bowel syndrome, premenstrual tension syndrome, cold intolerance, deconditioning, reduced exercise tolerance and restless leg syndrome. Diagnosis is based on reporting pain in at least 11 of the 18 tender points. Pressure over one of these areas can cause referred pain in peripheral locations.
The symptoms of pain and fatigue are chronic and the intensity varies unpredictably. Patients may find that they are so severely affected that they are unable to work in their professions or perform daily tasks. There is no known cure for fibromyalgia. Among the suggested therapies are:steroids, analgesics, hormone administration, antidepressants, physical therapy, xylocaine injections into the tender points to allow for exercise and education on coping with chronic pain. Most patients can expect to have the symptoms lifelong. The common analgesics seem to have minimal effect. While strong analgesics such as codeine can diminish pain, these cannot be taken for long periods of time. Patients who are able to exercise routinely can experience improvement. Xylocaine injections may give enough temporary relief so that the patients can exercise, but these injections are inconvenient for daily use. For some patients, antidepressants also seem to help. Most doctors treating fibromyalgia patients suggest a combination of medical treatment, moist heat, and exercise. Because of the varied responses to treatment, patients are encouraged to make careful observation of any treatments that seem to offer some alleviation of symptoms and, based on their observations, to devise a personalized regimen. Otherwise, those who are afflicted must learn to live with the symptoms and a greatly reduced quality of life.
The need remains for compositions and methods of alleviating the symptoms of fibromyalgia, without inducing deleterious side effects.